MEDICARE: BERINGER DRUG STORE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	P06107	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962488700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERINGER DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	102 W MAIN ST
Second Line	:	SUITE A
City	:	WARSAW
State	:	KY
Zip	:	41095-9300
Country	:	US
Telephone Number	:	859-567-4678
Fax Number	:	859-567-4674

Provider Business Practice Location Address
First Line	:	102 W MAIN ST
Second Line	:	SUITE A
City	:	WARSAW
State	:	KY
Zip	:	41095-9300
Country	:	US
Telephone Number	:	859-567-4678
Fax Number	:	859-567-4674

Authorized Official
Title or Position	:	V.P.
Name	:	MRS. PATRICIA DOROTHY LONG
Credential	:
Telephone Number	:	386-698-3737

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	08/22/2020

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